Compartment Syndrome

SURPRISE!!! ^_____________^

What is Compartment Syndrome?

Compartment syndrome is a painful condition that occurs when there is increased tissue pressure within a limited space (e.g. cast, muscle compartment). This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.

Compartment syndrome can either be: acute or chronic.

Acute compartment syndrome is a medical emergency. It

is usually caused by a severe injury. Without treatment, it can lead to permanent muscle damage.
Chronic compartment syndrome, a.k.a. exertional

compartment syndrome, is usually not a medical emergency. It is most often caused by athletic exertion.

Acute Compartment Syndrome

> most often occurs in the anterior (front) compartment of the lower leg (calf). > it can also occur in other compartments in the leg, as well as in the arms, hands, feet, and buttocks.
Clinical Features: 6 Ps 1. pain (especially on passive stretching) classic sign 2. pallor 3. perishingly cold 4. pulselessness 5. paresthesia 6. paralysis- late sign
*This does not usually happen in chronic compartment syndrome.

Complications. . .
of acute compartment syndrome are

irreversible!!
As swelling increases and muscle loses its blood supply, cells eventually die and muscle necrosis occurs.

 ischemic contracture and loss of function of the limb that

will lead to amputation

infection permanent nerve damage

rhabdomyolysis
kidney damage

Pathophysiology
| | | | | | | V

Predisposing factors: none

Increased intracompartmental pressure Decreased compartment size Increased compartment content

Decreased arteriolar pressure Vasospasm

Precipitating factors: 1. taking aticoagulants 2. Hemophillia 3. Participation in sports 4. Bandages and casts that are worn too tight 5. Recent injury to the area

Increased venous pressure Increased capillary pressure Increased exudation

Decreased arteriolar transmural pressure difference

Closure of arterioles

Increased capillary permeability

Muscle and nerve necrosis Decreased tissue perfusion

Emergency Actions & Mgt.

Maintaining the extremity at the heart level (not above heart level), and opening and bivalving the cast or opening the splint, if one

or the other are present..

Bivalving - a cast that is cut in half to detect

or relieve pressure underneath, especially when a patient has decreased or no sensation in the portion of the body surrounded by the cast.

Medical Management
PROMPT management of acute compartment syndrome is

essential
Elevation of the extremity to the heart level Release of restrictive devices

Guidelines to Bivalve a Cast

With a cast cutter, a longitudinal cut is made to divide the cast in half. 2. The underpadding is cut with scissors. 3. The cast is spread apart with cast spreaders to relieve pressure and to inspect and treat the skin without interrupting the reduction and alignment of the bone. 4. After the pressure is relieved, the anterior and posterior parts of the cast are secure together with an elastic compression bandage to maintain immobilization. 5. To control swelling and promotion circulation, the extremity is elevated (but no higher than heart level, to minimize the effect of gravity on perfusion of the tissues.
1.

 FASCIOTOMY a surgical decompression with excision of the fascia; is indicated to relieve the constrictive muscle fascia.

Emergency Actions & Mgt.

Wound is not sutured, left open.

Cover wound with moist, sterile saline dressings or artificial skin.

Splint

Passive ROM exercises ( 4 6 hours )

Skin graft 3 5 days Oxygen through the nose or mouth Fluids given intravenously Pain medications

The End